Gringauz Irina, Weismann Jonathan, Justo Dan, Adunsky Abraham, Segal Gad
Department of Internal Medicine T.
Rappaport School of Medicine, Technion Institute of Technology, Haifa.
Int J Rehabil Res. 2018 Mar;41(1):41-46. doi: 10.1097/MRR.0000000000000258.
Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P<0.05). A logistic regression analysis adjusted for age and sex showed that patients with ALT more than 10 IU/l were more likely to have higher (second to fourth upper quartiles) total FIM scores (>50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56-1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.
低丙氨酸氨基转移酶（ALT）血水平与老年人的衰弱及不良预后相关。因此，我们研究了髋部骨折手术后老年人康复前ALT血水平与康复结局之间的关联。纳入了490例髋部骨折手术后接受康复治疗的老年人（年龄>60岁，平均年龄：82.9±6.7岁，女性占82.0%）。康复结局通过功能独立性测量（FIM）评分进行评估。在康复前1至6个月记录ALT血水平。排除ALT血水平超过40 IU/l可能与肝损伤相符的患者。该队列分为两组：ALT大于10 IU/l的患者和ALT小于或等于10 IU/l的患者。康复出院时，ALT大于10 IU/l的患者相对于ALT小于或等于10 IU/l的患者，FIM结局指标（运动、认知、增益、效率）显著更高（P<0.05）。经年龄和性别调整的逻辑回归分析显示，ALT大于10 IU/l的患者在康复出院时更有可能获得更高（第二至第四上四分位数）的总FIM评分（>50）、认知FIM评分（>16）和FIM效率（>0.228）（优势比=1.56 - 1.78）。然而，在对入院总FIM评分、认知障碍、癌症和血清白蛋白水平进行调整后，这种关联不再显著。康复前ALT血水平处于高正常范围与髋部骨折手术后老年人更好的康复结局相关。当无法获得入院FIM评分、认知障碍、癌症和血清白蛋白水平的数据时，这一指标可能有用。
